The latest in AHCA drama

THE LATEST IN AHCA DRAMA: The House GOP’s Obamacare alternative is still skidding over ice and it’s uncertain as to whether the drivers will be able to regain control. On Wednesday, Reps. Leonard Lance and Dave Brat declared they weren’t going to vote for the bill in its present form. The pair’s reluctance sums up perfectly the GOP dilemma. Lance doesn’t like the CBO’s score of the bill, which projected 24 million Americans will lose insurance coverage; Brat, a Freedom Caucus member, wants a more conservative bill.

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Brat’s opposition could be especially consequential. Today, the House Budget Committee — which Brat belongs to — votes on the AHCA. With Brat’s defection, the bill can only afford to lose four more Republican members to make it out of committee. Brat himself doesn’t know how the vote will turn out.

WHAT’S BEEN SQUEEZED OUT OF THE SKINNY BUDGET: What will be the full extent of the cuts at HHS and the agencies touching health IT? Midnight Thursday, we got the first taste: $6 billion in cuts to NIH, with the Institutes absorbing the Agency for Healthcare Research and Quality.

The cuts to HHS are a part of the administration’s goal to redirect spending to national security. White House OMB Director Mick Mulvaney told reporters the president’s 2018 spending plan will add $54 billion in defense spending while cutting “dollar-for-dollar” from other programs and agencies that are deemed ineffective or wasteful.

— Other HHS questions: Will ONC’s funding remain stable in the face of such large cuts? The Obama administration routinely asked for bumps in funding, only to get denied by Congress. With the passage of the 21st Century Cures Act, ONC is expected to do more. How much money will it get to carry out that agenda?

THURSDAY: Your correspondent was deeply amused by this photo album of an “autonomous car trap”: enclosing a self-driving car entirely with fake traffic lines, so the car “thinks” it can’t move for fear of crossing over into another lane. We hope the trap works – we’d hate that the computers have gained so much competence they can see through our simple tricks. Describe simple tricks at dtahir@politico.com. Discuss socially at @David_Pittman, @arthurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.

GAO: PEOPLE AREN’T LOOKING AT THEIR ONLINE DATA: The Government Accountability Office took aim at the accessible data requirement in meaningful use in a report released Wednesday. The report, requested by the Reboot group (which include Sens. Lamar Alexander and John Thune), argues that while the vast majority of hospitals and eligible professionals make data available for patient and caregiver consumption, the percentage actually following through isn’t high — perhaps 15 to 30 percent, depending on the care setting and data analyzed.

Now, why that’s the case is the familiar debate — is it a lack of interest from patients, or perhaps technical difficulties? A GAO analysis suggests the former is definitely at play. The office analyzed the top 10 most popular EHRs and found patient participation rates ranging from 10 to 48 percent.

Ultimately, however, GAO hits ONC for its lack of performance measures for its initiatives — whether, for example, using Blue Button increases patient uptake of data. HHS and ONC concurred with the recommendation.

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CDS WORKS FOR PREVENTING KEY SURGERY SIDE EFFECT: A review of research on the use of computerized decision support shows that the software is quite effective in helping prevent venous thromboembolism, a common adverse event during surgery. The software forces clinicians to take a hard look at any patient risk factors for the condition, which translates to prevention, says the study in JAMA Surgery.

There’s an interesting rub to the analysis, though. None of the 11 studies included in the review involved clinical decision support embedded in Epic EHRs, the authors said. In an accompanying commentary, Brandyn Lau and Elliot Haut of Johns Hopkins University argue for the creation of CDS tools against conditions like thromboembolism that can be plugged into any EHR system.

CALL US: Or reach out about MIPS, says the Medical Group Management Association to CMS. The association sent a letter Wednesday to new CMS Administrator Seema Verma, asking the agency to let doctors know about whether they need to meet MIPS reporting requirements. It’s three months into 2017, and doctors don’t know, “generating considerable frustration and confusion.”

PDMP UPDATE: Some notes from prescription drug monitoring programs:

— Florida: The Florida House’s Health Care Appropriations Subcommittee favorably reported a PDMP-strengthening bill 13-0 to the full Health and Human Services Committee on Tuesday. The bill shortens dispense reporting times from a week to the next business day, among other changes to the program.

— House: A bipartisan group of members – Republican Reps. Brad Wenstrup and Jack Berman, along with Democratic Reps. Julia Brownley and Ann Kuster — introduced the VA Prescription Drug Accountability Act on Wednesday. The bill would require the VA to share all its prescription data with state PDMPs. Currently, the co-sponsors say, the department dispenses prescription data for veterans, not dependents or other patients. That means the department is sharing info on 90 percent of its patients.

MORE OPPOSE THE EMPLOYEE WELLNESS BILL: The National Organization for Rare Diseases announced its opposition to the Preserving Employee Wellness Programs Act, which critics believe would open the door to wellness programs being able to demand genetic information from employees.

VA STILL UNDER SCRUTINY: The VA’s information technology practices are still a big target for legislators, with a hearing Wednesday by the Senate Veterans Affairs Committee examining GAO’s assessment that the VA is a high-risk department. While the GAO and senators took a broad review of the department’s performance, software came up several times.

“VA has a high number of legacy systems needing replacement,” said Michael Missal, the inspector general for the department, specifically singling out the department’s scheduling software failures.

Scheduling software came up later in the hearing, with Jennifer Lee, the department’s Deputy Under Secretary for Health for Policy and Services, providing an update on the commercial rollout. The agency had decided to use a home-grown update to its current software as a provisional bridge to MASS, the commercial replacement. The home-grown update should roll out nationwide over the course of the summer, Lee indicated.

In general, senators seemed to favor commercial software in all respects — whether for scheduling or VistA.

PENNSYLVANIA SAFETY ADVISORY ON MEDICATION HIT: The Pennsylvania Patient Safety Authority has released a new analysis of HIT-related medication adverse events. In the first half of 2016, the Authority received 889 HIT-related reports; 615 errors actually reached the patient. Downtime, incorrect weight documentation, and confusing interfaces were highlighted by the authors.

** A message from Thermo Fisher Scientific: Healthcare is now being delivered more affordably and effectively, and governments, academia, insurers, pharma/biotech manufacturers, clinicians and others are collectively investing trillions in precision medicine to accelerate efforts. For its part, Thermo Fisher is aggressively investing in the development of analytical technologies and services to support government-, academia- and industry-led initiatives. These range from population health studies, such as the Saudi Human Genome Project, and translational research, including groundbreaking liquid biopsy studies, to molecular diagnostics for cancer and other diseases and targeted therapies, including an enabling technology that is now part of an FDA-approved CAR-T therapy for certain forms of leukemia. Watch Kristin Pothier, global head of life sciences for Parthenon-EY, discuss similar global efforts as well as takeaways from her new book Personalizing Precision Medicine, which spotlights promising advancements and remaining hurdles on the path to clinical utility and, eventually, universal precision health. Visit thermofisherPM.com**

About The Author

Darius Tahir is an eHealth reporter for POLITICO Pro. Before joining POLITICO, Darius worked for Modern Healthcare (where he covered health care technology) and the Gray Sheet (where he covered medical devices and digital health).

Darius graduated from Stanford in 2009 — meaning he absorbed just enough sunshine and tech optimism to develop a fascination.